Myelodysplastic syndrome (MDS) patients at a VA medical center: Comorbidity and survival.

Abstract

6611 Background: To determine whether co morbidity indices predict survival in myelodysplastic syndrome (MDS) patients. Methods: In an IRB approved protocol, we reviewed the records of patients (pts) diagnosed with MDS at a VA Medical Center from June 1998 to December 2009. Records were reviewed for demographic, clinical and pathological data, ECOG PS, Erythropoietin use and response, transfusion dependency, International Prognostic Scoring System (IPSS), total number of treatments and survival. Cox survival regression analysis was performed. Comorbidity was assessed with three co morbidity indices, the Charlson Comorbidity Index (CMI), the Kaplan-Feinstein Index (KFI) and the Cumulative Illness Rating Scale (CIRS). Results: There were 81 analyzable pts with a median (M) age of 74.5 (47-94). The M hemoglobin was 9.5 g/dl (4.3-16.9), M WBC 5.05 K/cmm (1.2-100), M platelets 158.5 K/cmm (10-1346), M albumin 3.9 g/dL (0-5), M ferritin 378 ng/mL (0-7750), M LDH 188 IU/L (0-2426). The M CMI was 2 (0-8), M KFI 2 (0-3), M CIRS 15 4 (0-10), M CIRS 16 7 (0-19), M CIRS 17 1.7 (0-3), and M survival was 925 days (14-3871). Of the 63 pts (77.8%) who received treatment, 34 (42.5%) received an erythroid stimulating agent, 9 (11.25%) lenalidomide, and 8 (10.1%) azacytidine. There were 28 (34.2%) who were transfusion dependent with the M number of transfusions was 4 (0-100). In the univariate survival analysis, hemoglobin, wbc, platelets, ferritin, LDH, albumin, and transfusion dependency were significant predictors of survival. Of the co morbidity indices, only Charlson CMI and CIRS 19 were significant; age, race, KFI, CIRS 15, 16, 17, and 18 were not significant. In the multivariate analysis, hemoglobin (p < 0.0040), LDH (p < 0.0016), transfusion dependency (p < 0.0028) and CIRS 19 (p < 0.0303) were independent predictors of survival. Conclusions: Severe comorbidity, as reflected in the CIRS19, may be an independent predictor of survival. Further analysis of a larger sample will be needed. This was supported by the New Jersey Commission for Cancer Research 09-1133-CCR-EO. No significant financial relationships to disclose.